Provider Demographics
NPI:1396002796
Name:NEWMAN, GRACE INGRAM (BS, MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:INGRAM
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:BS, MD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:CHRISTIAN
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MD
Mailing Address - Street 1:7695 POPLAR PIKE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-5947
Mailing Address - Country:US
Mailing Address - Phone:901-302-5989
Mailing Address - Fax:901-682-9747
Practice Address - Street 1:1265 UNION AVENUE
Practice Address - Street 2:7 THOMAS
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-685-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS256852085R0202X
390200000X
TN573642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program